J Clin Outcomes Manage
From bad to better: a qualitative assessment of low-performing hospitals that improved their smoking cessation counseling performance
Hafner JM, Williams SC, Morton DJ, Koss RG, Loeb JM
Abstract Objective: To identify factors that contributed to improvements in the rate of smoking cessation counseling delivered to patients with acute myocardial infarction, heart failure, and pneumonia in a sample of low-performing hospitals. Design: Qualitative research. Setting and participants: 7 hospitals with significant performance improvement and 7 hospitals with limited or no improvement on national standardized measures of smoking cessation counseling. Hospitals were selected from 210 hospitals reporting performance measure rates in the lower 25th percentile for 2 consecutive quarters at baseline. Interviews were conducted with administrative and front-line staff involved in providing or supervising smoking cessation counseling services and quality improvement activities. Measurement: The 28 interview questions primarily focused on the hospitalís current approach to smoking cessation counseling, the challenges in program implementation, and general perceptions about smoking cessation counseling efforts. Results: Hospitals that improved reported actively involved leadership, use of multidisciplinary team approaches, and collaboration between leadership and front-line staff to address documentation issues, education, and perceived barriers. Conclusions: Smoking cessation counseling is a valuable preventive intervention, especially when delivered by a diverse group of health care professionals. With senior leadershipís active support of improvement efforts, hospitals initially identified as low performers successfully improved their rates.
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